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Medicaid Insurers Seek More Funds From State

This article is more than 6 years old.

Companies that insure Medicaid patients in Massachusetts are pressing for an increase in the payments they receive from the state for serving low-income residents.

The health insurers say $140 million in losses since the start of the year are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members, many of them with major health problems, assigned to the companies by MassHealth, the state Medicaid program.

Insurers say the state did not budget enough money to cover added costs.

"The program is in flux and in disarray," said Susan Coakley, interim chief executive of Boston Medical Center's Health Net, the largest of the Medicaid managed care insurers that provide coverage to low-income residents under contracts with the state.

Deborah Enos, Neighborhood Health Plan president, whose organization accounted for about $99 million of the losses incurred by the Medicaid plans, tells The Boston Globe insurers believe the state understands the severity of the burden.

State officials said they are not convinced that analysis of the costs is accurate, but they are expected this week to propose higher reimbursement rates to the insurers for the fiscal year starting Oct. 1 that will reflect updated data on medical and drug costs.

There's no indication the problems affecting insurers have compromised patient health. While thousands have been assigned new insurance coverage, most have kept their doctors.

MassHealth provides Medicaid insurance, partly funded by the federal government, to more than 1 million low-income Massachusetts residents. The state agency insures some of those people directly, but about three-quarters are served by a half-dozen private Medicaid insurers.

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